Provider Demographics
NPI:1801685375
Name:OSORIO, CARLA MIDORI
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MIDORI
Last Name:OSORIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ELDERGLEN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3362
Mailing Address - Country:US
Mailing Address - Phone:949-316-7487
Mailing Address - Fax:
Practice Address - Street 1:1509 BUENA VIS APT 202
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5908
Practice Address - Country:US
Practice Address - Phone:714-202-6857
Practice Address - Fax:855-978-0433
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant